…may be markedly elevated even when overt congestion is not apparent. Such a discrepancy should prompt consideration of an infiltrative cardiomyopathy within the appropriate clinical…

…are elevated. The syndrome is therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure…

…a chronic inflammatory disease of the arteries. It has become increasingly clear in the past few decades that atherosclerosis is not caused by the passive…

…coronary cause of symptoms. CCS is a clinical syndrome rather than a permanently stable state. Patients may remain stable for prolonged periods, but chronic coronary…

…to fluid retention and worsening congestion The clinical course may be chronic and relatively stable or punctuated by episodes of worsening heart failure requiring hospitalization…

…may produce cardiorenal syndrome. Worsening renal function in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to…

…chronic angina, an anginal equivalent or exertional dyspnoea. Patients may continue to have lifestyle limiting symptoms despite guideline directed medical therapy (GDMT), prompting consideration of…

Cardiology Coronary Atherosclerosis Coronary atherosclerosis is a chronic, progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…Chronic, low grade systemic inflammation Insulin resistance Abnormal adipokine signalling Endothelial dysfunction Dyslipidaemia A prothrombotic state Albuminuria and declining estimated glomerular filtration rate Development of…

…guidelines. Hence, this chapter will present the most recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease…

…atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by the subendothelial accumulation of apolipoprotein B containing…

…guidelines. Hence, this chapter will present the most recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease…

…ischemia and infarction Pharmacology & dosing Definition and therapeutic objectives Antianginal therapy in chronic coronary syndrome (CCS) is directed primarily at reducing myocardial ischaemia and relieving…

…or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of obstructive coronary artery disease (CAD) before diagnostic testing…

…injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis, elevated liver enzymes or transaminases…

…because quality of life is often poor, hospitalizations are frequent, and healthcare resource utilization is high. Clinical Presentation and Symptoms The dominant manifestation is chronic…

…parietal and visceral leaves of the pericardium are most often fused. The process most often affects the entire pericardium. Constrictive pericarditis is most often chronic…

CPR It is commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced…

…ACE) inhibitors are foundational therapies in cardiovascular medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction …

…Definition and Pathophysiology Angiotensin converting enzyme inhibitors (ACE inhibitors) constitute a cornerstone in the management of cardiovascular disease, heart failure, and chronic kidney disease (CKD)…

…Reversible ischemic dysfunction Chronic hypoperfusion with hibernating myocardium Post ischemic stunning Adverse left ventricular (LV) remodeling Ischemic cardiomyopathy is the leading cause of heart failure…

…chronic coronary syndrome (CCS), peripheral artery disease (PAD), and acute coronary syndromes (ACS). Its principal therapeutic objective is reduction of low density lipoprotein cholesterol (LDL…

…acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction…

…hypertension (CTEPH) and chronic thromboembolic pulmonary disease Group 5: PH with unclear or multifactorial mechanisms PAH is a distinct and uncommon form of precapillary PH…

…chronic pericardial effusions to cause sudden cardiac arrest since these cases tend to be recognized and managed before circulatory collapse occurs. The leading causes of…

…concurrent use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic heart…

…NIV are two different treatments with different physiology, and the commonest source of error is confusing them. CPAP delivers a constant pressure that recruits alveoli…

…applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick…

…Comment : : : MAP ≥ 65 mmHg 80–85 mmHg in chronic hypertension or when there are signs of inadequate perfusion Urine output 0.5 mL/kg/h…

…4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only…

…morphine Morphine has an active renally excreted metabolite that causes late sedation and respiratory depression Marked liver failure A reduced dose of all of them…

…coach actively, and do not accept a trace you would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze or…

…retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient…

…kidney or liver disease, especially when combined with diuretics (risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive pulmonary disease…

…identifying and staging chronic kidney disease (CKD), facilitating early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of eGFR in clinical…

…with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual…

…disease . It integrates multiple variables, including the number of lesions, their location, and specific characteristics such as bifurcations, chronic total occlusions (CTOs), calcification, and thrombus…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…the time of assessment. Ongoing chest discomfort with electrical or haemodynamic instability. Cardiac arrest or cardiogenic shock. Features that favour ACS rather than chronic stable…

…after PCI; reduce recurrent atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant bleeding. Long term…

Cardiology Definition and purpose Cardiovascular risk assessment estimates an individual’s probability of experiencing cardiovascular disease (CVD) over a defined period. SCORE2 and SCORE2 Older…

…with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine…

…importance of residual disease is also influenced by anatomic complexity and comorbidity, which themselves may contribute to progression of native coronary artery disease. The chronic…

…with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with chronic kidney disease, particularly diabetic kidney…

…whether ACS or chronic coronary syndrome (CCS). Whether and how PCI was performed. The need for non cardiac surgery. The presence of an indication for…

…in the chronic coronary syndrome lipid lowering recommendations. Acute coronary syndrome The period immediately following ACS is associated with particularly high risk of recurrent cardiovascular…

…elevation without evidence of ischaemia represents acute myocardial injury rather than MI. Persistent elevation without a significant dynamic change is consistent with chronic myocardial injury…

…angina caused by disease in the treated segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary syndrome (ACS)…

…chronic kidney disease (CKD), and peripheral artery disease (PAD). Figure 1 (below) shows weight loss effects of novel multi agonists in recent clinical trials (Rawshani…

…In chronic coronary syndrome, the recommended LDL C objective is: LDL C <1.4 mmol/L (<55 mg/dL) , and A reduction of at least…

…or progress to chronic limb threatening ischaemia (CLTI). Clinical presentation and symptoms Asymptomatic and atypical disease Fewer than half of patients with PAD have typical…

…Hypertension. Absence of an adequate collateral circulation. A first or anterior infarction. Single vessel disease without collateral support. Chronic kidney disease, particularly in relation to…

…coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to chronic limb threat

…by separation within the coronary arterial wall, usually through formation of an intramural haematoma that compresses the true lumen. The resulting reduction in coronary blood…

…restoration of epicardial flow. The electrocardiographic appearance depends on several interacting factors: The stage of the ischaemic process: acute, evolving or chronic The severity of…

…Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings…

…and peripheral artery disease (PAD). Diabetes also substantially increases the risk of chronic kidney disease (CKD), which itself promotes cardiovascular disease and amplifies cardiovascular and…